The rise of fatal fentanyl overdoses across Ohio may turn out to be even worse than expected, with at least one county reporting a six-fold increase in 2015 and another on the verge of eclipsing its 2015 numbers in just three months.

In 2014, preliminary fatal overdoses involving fentanyl, an opioid that is 30 to 50 times more potent than heroin, increased six-fold from 2013. Eighty percent of the 502 deaths occurred in 14 counties. Half of those counties reported to Gannett Ohio this week preliminary numbers for 2015 that collectively have doubled.

Clark County reported a six-fold increase from 8 to 49 fentanyl-related deaths in 2015, while in just three months this year, Cuyahoga County is within striking distance of the 92 it saw in 2015, putting it on pace to at least triple fentanyl-related fatal drug overdoses this year. Such an increase would nearly double the county's overall drug overdoses.

The Ross County deaths prompted Minney and other partnership leaders to fast-track a new approach: an overdose response team. The team includes an officer or deputy and drug treatment provider who follow-up with resources at homes where there has been a non-fatal drug overdose in the preceding two days.

“We want this to be seen as anything but an adversarial relationship. This is about saving lives,” Minney said.

The team made its first outing Thursday to five homes where handouts and a phone number were left at three homes and contact was made with one man who had overdosed, and they spoke with family of another.

“(The man who had overdosed) was very grateful this was a program that’s been started. He was very receptive and had great hope he can move through treatment. That really reassures us that this is the right thing to do,” Minney said.

The program also aims to connect families with resources, like SOLACE of Ross County. Although Ross County’s unintentional fatal drug overdoses have skyrocketed from 15 in 2013 to 39 in 2015, SOLACE has not had more families looking for support, said director Tammy Hettinger.

“I think there’s still the stigma of not wanting everybody to know,” said Hettinger, who started SOLACE in the midst of a family member’s battle with addiction. “For me (to open up), it just got to the point where I got tired of hurting and not knowing what to do.”

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Tammy Hettinger, Solace of Ross County coordinator, gives a tour of the men's shelter Thursday in Sherman Park. Solace of Ross County has moved its offices to the shelter.(Photo: Jess Grimm/Chillicothe Gazette)

No significant sign of slowing

After Ohio's preliminary 2014 numbers revealed a six-fold increase in fentanyl-related deaths, the state asked the Centers for Disease Control to do a report, which was released last month. Among the CDC's findings was the sharp increase in fentanyl-related overdose deaths appeared to coincide with law enforcement seizures of illicit fentanyl.

The 1,110 fentanyl cases seen at the state's crime lab is triple the number seen in 2014 and more than 28 times what it had in 2013. As of March 30, the lab reported processing 369 fentanyl cases in 2016, putting the state on track for a 33 percent increase this year. Some fentanyl and heroin is showing up in the state in a new form, pills created to mock the appearance of prescription painkillers.

Investigators are still working to determine the primary sources of fentanyl and the pills, said Attorney General Mike DeWine.

"Most of the fentanyl being used is made in secret labs, so some of this may be within Ohio," he said.

Although Ohio has made progress, particularly on the side of decreasing prescriptions of painkillers and doctor shopping, DeWine said we still need more treatment along with "much, much more" prevention and education. On the law enforcement front, he said local law enforcement needs to continue tapping the Heroin Unit created nearly four years ago for additional expertise and tools for drug investigations.

As the CDC suggested, early indications from 2016 indicate fentanyl-related overdoses also continue to increase. Clark County Coroner Dr. Richard Marsh said things haven't changed much this year.

“We’re seeing basically the same pattern we did (in 2015),” Marsh said.

​Marsh has another 13 deaths he suspects are overdoses, but he’s awaiting the toxicology reports.

“The toxicology labs are overworked because we’re having so many deaths,” said the Clark County coroner.

Aside from an increase in the number of deaths causing delays, the mixture of drugs, some of which are very complex, also makes testing more laborious, said Dr. Robert Forney, director of toxicology for the Lucas County Coroner's Office.

Forney's team does toxicology reports for 21 counties, including Sandusky and Ottawa and two in Michigan. Across the region in 2015, they handled 215 overdoses where heroin and/or fentanyl was present, which was up from 145 in 2014. While fentanyl is still prevalent this year, Forney said the levels of it found during toxicology tests indicate it may be less potent than seen in 2015.

"This whole thing is scary. I've been doing this 40 years and I've never seen anything like this. … The joke around the office is we've become a drug death processing center. It used to be a percentage of what we do, now it's like most of what we do," Forney said. "The genie is out of the bottle and I don't know how we put it back in."

Like the state’s call to the CDC to study its fentanyl-related overdose deaths,Clark County officials have implemented a drug death review program that involves a deep dive into the characteristics of those who died. The expectation is the report will help direct community resources and efforts toward the right people and parts of the county.

Other communities are doing the same, including Clermont and Ross counties, while others, like Cuyahoga County, already have been doing that deeper dive into the deaths.